Complete cohort - Case 58 of 83
Case 73
Assigned out-of-fold recommendation
Coil embolization alone
Alternative: Stent-assisted coil embolization
View A is AP; View B is lateral, as confirmed by the data provider.
Case summary
An 80-year-old woman presented with subarachnoid hemorrhage and a 4.2mm x 3.7mm aneurysm with a 3mm neck projecting posteriorly from the left supraclinoid ICA communicating segment.
Image observation
On the supplied views, the aneurysm appears to project posteriorly from the ICA with a moderate-sized posterior communicating artery arising from the neck region.
Model-generated clinical rationale
The assigned recommendation of coil embolization alone is supported by the aneurysm's small size and the patient's advanced age, which favors a less invasive approach. However, the 3mm neck width and the presence of a moderate-sized PCOM artery at the neck suggest that coil stability may be compromised without adjunctive support.
Model uncertainty
The OOF score distribution was diffuse: Coil embolization alone ranked first, but Stent-assisted coil embolization remained a material alternative.
Clinical uncertainty / missing factor
The critical missing decision factor is the precise morphological relationship between the aneurysm neck and the PCOM origin, which determines the feasibility of simple coiling versus the need for stent assistance.
Explicit evidence used
4.2mm x 3.7mm aneurysm with 3mm neck | Moderate sized PCOM artery